Devices for image-guided light treatment of skin

ABSTRACT

In one aspect, devices for light treatment of skin are described herein. A device described herein, in some embodiments, comprises an interior compartment having a proximal end and a distal end, and an optical aperture disposed at the distal end. The device also comprises a laser or BBL source that produces a laser or BBL beam. The laser or BBL beam has a first optical path within the interior compartment, between the proximal end and the distal end. Additionally, the first optical path exits the interior compartment through the optical aperture. The device further comprises a camera that receives light from the aperture. The light received from the aperture has a second optical path within the interior compartment. Further, a selectively reflective optical element is disposed in the first and second optical paths. The selectively reflective optical element generally transmits the laser or BBL beam but generally reflects at least a portion of the light from the aperture toward the camera.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is the national stage application under 35 U.S.C. § 371of International Application No. PCT/US2017/017571, filed on Feb. 11,2017, which claims priority pursuant to 35 U.S.C. § 119 to U.S.Provisional Patent Application Ser. No. 62/294,915, filed on Feb. 12,2016, each of which is hereby incorporated by reference in its entirety.

FIELD

This invention relates to devices and methods for treating skin and, inparticular, to devices and methods for the treatment of skin withlasers.

BACKGROUND

Many skin conditions can be treated with lasers. In general, laser lightis selectively delivered to specific areas of the skin in such treatmentmethods. Selective and precise delivery of laser light to a specificarea of skin can improve safety, increase treatment efficacy, andminimize adverse, undesired effects of treatment. However, in manytreatments, target areas of skin are very small. For example, in somecases, target areas of skin have dimensions of less than one millimeter.Thus, laser treatment of skin often requires microscopically precisetargeting of laser light. Unfortunately, many current laser treatmentdevices are not capable of such precise delivery of laser light to skin.There is accordingly a need for improved devices and methods forprecisely delivering laser light to desired areas of skin.

In hyperhidrosis, an excess of sweating is observed in certain areas ofthe skin, including in the axilla, on the palms of the hands, and on thesoles of the feet. One common way to address hyperhidrosis is the use ofdeodorants and/or antiperspirants. However, the action or effectivenessof deodorants and antiperspirants are often limited to several hours.Other existing treatment methods of hyperhidrosis include surgicalremoval of sweat glands from under the skin, application of a botulinumtoxin, or destruction of sweat pores by the application ofelectromagnetic radiation in the microwave region of the spectrum. Whilethese techniques can be effective in certain cases, these techniques canalso suffer from one or more disadvantages. For example, the use of abotulinum toxin is currently not cleared for palms and soles, andtreatment with a botulinum toxin provides only temporary relief ofsymptoms. As another example, the use of microwave radiation isassociated with high tissue morbidity. Thus, there is a need forimproved devices and methods for treating various skin conditions suchas hyperhidrosis or unwanted hair, including in a manner that is safe,efficient, and/or permanent.

SUMMARY

In one aspect, devices and methods for treating skin are describedherein which, in some cases, can provide one or more advantages comparedto some other devices and methods. For example, in some embodiments, adevice described herein can enable the precise delivery of laser lightto a desired region of skin or other target surface. Additionally, insome embodiments, a method described herein can treat a variety of skinconditions through the precise targeting and/or destruction of variousskin components, such as eccrine glands or hair follicles. Moreover,devices and methods described herein can combine laser delivery withskin imaging in a single device and/or process. Additionally, in somecases, a method or device described herein provides automated visualidentification of skin treatment targets followed by computer- andopto-mechanically-guided laser treatment of the identified targets.Methods and devices described herein can also provide safe, efficient,and/or permanent treatment of various skin conditions or diseases.

In one aspect, devices for the laser treatment of skin (or other targetsor surfaces) are described herein. In some embodiments, such a devicecomprises an interior compartment having a proximal end and a distalend, and an optical aperture disposed at the distal end. The device alsocomprises a laser or Broad Band Light (BBL) source that produces or ispositioned or configured to produce a laser or BBL beam. The BBL sourcecan be produced from an intense flashlamp derived incoherent light beam,which is sometimes called Intense Pulsed Light (IPL). For referencepurposes herein, the term “BBL” will be used to refer to BBL and IPL,such that the two terms are interchangeable. The laser or BBL beam has afirst average wavelength and a first optical path within the interiorcompartment of the device, between the proximal end and the distal endof the device. Additionally, the first optical path of the laser or BBLbeam exits the interior compartment of the device through the opticalaperture. A device described herein can also comprise a light sourcethat illuminates an area targeted and/or imaged by the device. Moreover,the device further comprises a camera. The camera receives light, or ispositioned or configured to receive light from or through the opticalaperture. The light received from or through the optical aperture has asecond average wavelength and a second optical path within the interiorcompartment of the device. The second average wavelength of the lightreceived from or through the optical aperture generally differs from thefirst average wavelength of the laser or BBL beam. The first opticalpath of the laser or BBL beam also generally differs, at least in part,from the second optical path of the light received by the camera from orthrough the optical aperture of the device. In addition, a devicedescribed herein further comprises a selectively reflective opticalelement, such as a selectively reflective plate. The selectivelyreflective optical element is disposed in both the first optical pathand also in the second optical path. Moreover, the selectivelyreflective optical element transmits at least 70% of the total intensityof the laser or BBL beam incident on the selectively reflective opticalelement, or is at least 70% transparent to the first average wavelengthof the laser or BBL beam. Additionally, the selectively reflectiveoptical element also reflects to the camera at least a portion of theincident light received from the optical aperture. More particularly,the selectively reflective optical element can reflect to the camera asufficient amount of incident light received from the aperture to permitthe camera to receive, record, construct, and/or process an image fromthe reflected light. The image generally corresponds to at least aportion of a targeted and/or imaged area of skin or a surface of skin.In some cases, the selectively reflective optical element reflects tothe camera at least 1% of the total intensity of incident light receivedfrom the optical aperture, or is at least 1% reflective to the secondaverage wavelength of the light received from or through the opticalaperture.

Moreover, in some cases, a device described herein further comprises anapplicator attached to the distal end of the interior chamber. Theapplicator is configured to couple, connect, or attach the device to asurface of skin of a patient, including for laser or BBL beam deliveryto the surface of skin and/or imaging of the surface of skin. In someembodiments, the applicator comprises a bottom surface adjacent to or indirect contact with the surface of skin, and the bottom surfacecomprises a window that is substantially transparent to the laser or BBLbeam and to the light received by the camera. Additionally, the bottomsurface of the applicator can be substantially flat or planar. Thebottom surface of the applicator may also be conformal to the surface ofskin. Further, in some instances, the bottom surface of the applicatorcomprises an adhesive for reversibly adhering the bottom surface of theapplicator to the surface of skin. In addition, in some embodiments, theapplicator comprises a non-permeable chamber and the bottom surface ofthe applicator forms one or more hermetic seals with the surface ofskin. The non-permeable chamber of the applicator may also be in fluidcommunication with a vacuum pump for supplying a vacuum to an interiorof the non-permeable chamber, thereby preventing or minimizing lateralmovement of the device relative to the surface of the skin being treatedand/or imaged. Further, in some cases, the applicator tracks relativemovement of the surface of skin of the patient in one or more lateraldirections relative to the optical aperture of the device.

A device described herein can also comprise one or more additionalcomponents. For example, in some embodiments, a device described hereinfurther comprises computer hardware and/or software for identifying aspatial location of one or more structures, components, or constituentsof skin (where the terms “structures,” “components,” and “constituents”of skin can be used interchangeably) proximate the distal end of thedevice. The device may also comprise computer hardware and/or softwarefor identifying or determining a class or type, size, shape, color,estimated depth, and/or shaft angle of one or more skin constituents.Further, the hardware and/or software can comprise software forcorrecting and/or calibrating image non-linearities or distortions fromthe second optical path or discrepancies in a mechanical model usedduring image processing. Additionally, the computer hardware and/orsoftware can be mechanically and electrically coupled to the camera ofthe device, including for processing image data and/or transmitting theimage data for further processing, presentation, or display.

A device described herein may also include one or more lenses, mirrors,and/or actuators for directing the light received from the opticalaperture to the camera and/or for directing the laser or BBL beam to oneor more desired locations on a surface of skin of a patient.Additionally, computer hardware and/or software of a device describedherein can also be used to control the foregoing components so as todirect the laser or BBL beam to a desired location within a treatmentarea of the skin of the patient, as described further below.

In another aspect, methods of treating skin or structures, components,or constituents of skin with a laser or BBL source are described herein.In some cases, such a method comprises removing, destroying, ablating,vaporizing, or coagulating (which can collectively be referred to as“treating”) a specific structure, component, or constituent of skin of apatient, including in a specific treatment area targeted by or incontact with a device described herein. Additionally, in someembodiments, a treated structure or constituent of skin is visuallylabeled or imaged prior to removal or ablation. As described furtherhereinbelow, such labeling and imaging of a structure or constituent ofskin can permit precise treatment of skin. In some cases, a methoddescribed herein comprises applying a contrast agent to a treatment areaof skin of a patient to produce a labeled structure of the skin. Themethod further comprises detecting the labeled structure of the skin inan image of the treatment area, and using the image to applyelectromagnetic radiation to the labeled structure. However, in otherembodiments, a structure of skin can be imaged without the use of acontrast agent. In some such cases, one or more “native” or naturallyoccurring features of the skin structure are used to visually identifythe skin structure. Additionally, in some instances, the electromagneticradiation used in a method described herein is a laser or BBL beamproduced by a device described herein. It is to be understood that thelaser or BBL beam or other electromagnetic radiation is applied to thelabeled or unlabeled structure of the skin at a power and for a durationsufficient to remove, ablate, vaporize, destroy, coagulate, or otherwisetherapeutically treat the labeled or unlabeled structure of the skin, ora portion thereof. In this manner, the labeled or unlabeled structure ofthe skin can be removed, ablated, vaporized, destroyed, or otherwisetreated or rendered non-harmful to the patient, including within thetargeted treatment area of the skin. As described further hereinbelow,methods described herein can be used to treat various skin structures orconstituents and/or various skin-related disorders or conditions. Forexample, in some embodiments, a structure described herein is a pore,gland, hair follicle, acne, skin lesion (which may be benign,pre-malignant, or malignant), blood vessel, or vascular lesion. In somesuch cases, the gland is an eccrine sweat gland, apocrine gland,apoeccrine gland, or sebaceous gland.

These and other embodiments are described in more detail in the detaileddescription which follows.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a schematic diagram of a device for laser treatment of skinaccording to one embodiment described herein.

FIGS. 2A and 2B are, respectively, plan and sectional views of a portionof a device for laser treatment of skin according to one embodimentdescribed herein.

FIG. 3 is a block diagram of an exemplary system for laser treatment ofskin according to some embodiments described herein.

DETAILED DESCRIPTION

Embodiments described herein can be understood more readily by referenceto the following detailed description, examples, and figures. Elements,apparatus, and methods described herein, however, are not limited to thespecific embodiments presented in the detailed description, examples,and figures. It should be recognized that these embodiments are merelyillustrative of the principles of the present invention. Numerousmodifications and adaptations will be readily apparent to those of skillin the art without departing from the spirit and scope of the invention.

In addition, all ranges disclosed herein are to be understood toencompass any and all subranges subsumed therein. For example, a statedrange of “1.0 to 10.0” should be considered to include any and allsubranges beginning with a minimum value of 1.0 or more and ending witha maximum value of 10.0 or less, e.g., 1.0 to 5.3, or 4.7 to 10.0, or3.6 to 7.9.

All ranges disclosed herein are also to be considered to include the endpoints of the range, unless expressly stated otherwise. For example, arange of “between 5 and 10” or “from 5 to 10” or “5-10” should generallybe considered to include the end points 5 and 10.

Further, when the phrase “up to” is used in connection with an amount orquantity, it is to be understood that the amount is at least adetectable amount or quantity. For example, a material present in anamount “up to” a specified amount can be present from a detectableamount and up to and including the specified amount.

I. Devices for Laser Treatment of Skin

In one aspect, devices for the laser treatment of skin (or other targetsor surfaces) are described herein. In some embodiments, such a devicecomprises an interior compartment having a proximal end and a distalend, and an optical aperture disposed at the distal end. The device alsocomprises a laser that produces, or is positioned or configured toproduce, a laser or BBL beam. The laser or BBL beam has a first opticalpath within the interior compartment of the device, between the proximalend and the distal end of the interior compartment. Additionally, thefirst optical path of the laser or BBL beam exits the interiorcompartment through the aperture. The device further comprises a camerathat receives, or is positioned to receive, light from the aperture. Thelight received from the aperture has a second optical path within theinterior compartment. In addition, a device described herein furthercomprises a selectively reflective optical element disposed in both thefirst optical path and also in the second optical path. The selectivelyreflective optical element generally transmits the laser or BBL beamincident on the selectively reflective optical element, and alsoreflects to the camera at least a portion of the incident light receivedfrom the optical aperture. A device described herein can also include anapplicator attached to the distal end of the interior chamber. Theapplicator is configured to couple the device to a surface of skin of apatient, including for laser or BBL beam delivery to the surface of skinand/or imaging of the surface of skin, as described further herein.Moreover, in some cases, a device described herein further comprises oneor more additional components, such as computer hardware and/or softwarefor identifying a spatial location of one or more structures orconstituents of skin proximate the distal end of the device and/or fordirecting the laser or BBL beam to one or more desired locations on asurface of skin of a patient. Such hardware and/or software can be usedto control or actuate one or more additional components of a devicedescribed herein, such as one or more lenses, mirrors, and/or actuators.

Specific components of devices described herein will now be described infurther detail. Exemplary devices according to the present disclosureare also described in the specific Examples hereinbelow, including withreference to the drawings.

Turning now to specific components, devices described herein comprise aninterior compartment. The interior compartment can have any size andshape not inconsistent with the objectives of the present disclosure. Insome cases, the interior compartment defines, comprises, consists of,consists essentially of, or is an interior volume or region of ahandpiece. Such a handpiece can be a laser or BBL treatment handpieceincluding a proximal end or a grip portion or member for gripping by auser of the handpiece. A handpiece can also include a distal end or headportion or member from which a laser is directed toward a target, suchas a target treatment area described herein. Additionally, a handpiecedescribed herein, in some embodiments, is attached to one or moreadditional components of a laser treatment system, such as a powersource. Moreover, a handpiece and/or interior compartment of a devicedescribed herein can be formed from any material not inconsistent withthe objectives of the present disclosure. For instance, in some cases,the handpiece and/or interior compartment is formed form a metal,plastic, a composite material (such as a fiber glass material), or acombination of two or more of the foregoing.

Devices described herein also comprise an optical aperture disposed atthe distal end of the interior compartment of a device described herein.An “optical aperture,” for reference purposes herein comprises anopening in the interior compartment that is used for the ingress and/oregress of light (such as laser light and/or light received from a targetarea for imaging purposes) into and/or from the interior compartment.The optical aperture can have any size or shape not inconsistent withthe objectives of the present disclosure. In some instances, the opticalaperture has a size sufficiently large to allow a laser or BBL beamdescribed herein to exit the interior compartment of the device and alsosufficiently large to permit the receipt of light from a target area forimaging purposes, including in a manner described herein. For example,in some, cases, an optical aperture or opening described herein has asize in one or two dimensions (e.g., a diametrical dimension, or lengthand width dimensions in a plane of the opening) of up to 5 cm, up to 3cm, up to 2 cm, up to 1 cm, up to 0.5 cm, or up to 0.1 cm. Otherdimensions are also possible. Further, in some embodiments, an opticalaperture described herein has a round or circular shape.

Additionally, devices described herein comprise a laser or BBL sourcepositioned or configured to produce a laser or BBL beam. It is to beunderstood that a “laser” can refer to a single lasing device thatproduces a single beam of laser light from a single lasing medium.Similarly, as understood by one of ordinary skill in the art, the terms“BBL” source and “BBL beam” can refer to a source and beam,respectively, of intense, broad-spectrum pulses of light, including asIPL is defined and approved by the U.S. Food and Drug Administration.More particularly, a BBL beam produced by a BBL source can comprisepulses of non-coherent or non-laser light having a wavelength from 500nm to 1200 nm, as described, for instance, in Raulin et al., “IPLtechnology: a review,” Lasers Surg. Med. 2003, 32:78-87. Any laser, BBLsource, laser beam, or BBL beam not inconsistent with the objectives ofthe present disclosure can be used. Moreover, the choice of laser, BBLsource, or laser or BBL beam can be based on a desired effect of thelaser or BBL beam and/or on a desired target of the laser or BBL beam.In some cases, for example, the beam is ablative, such as may be desiredfor destroying or removing a target component or constituent of skin.Alternatively, in other embodiments, the beam is non-ablative. The beammay also be coagulative, where a “coagulative” beam is understood tocause coagulation of tissue in a target area described herein. Further,in some embodiments, the laser of a device described herein comprises ahybrid laser operable to produce laser beams having a plurality ofdiffering wavelengths. For instance, in some cases, the hybrid laser isoperable to selectively produce an ablative laser beam and a coagulativelaser beam. It is also possible to use both a BBL source and a laser inthe same device. Thus, in some embodiments, a single device describedherein can be used to produce and deliver one or more beams (e.g., oneor more laser beams, or one or more laser beams in combination with aBBL beam) having a range of properties, as needed for a specifictreatment or other application of the device.

A laser of a device described herein may also be a pulsed laser or acontinuous wave (CW) laser. Moreover, when a pulsed laser is used, thelaser can produce time-modulated pulses of the laser beam. For instance,in some cases, the laser beam comprises an ablative laser beam and thelaser produces time-modulated pulses of the ablative laser beam. Notintending to be bound by theory, it is believed that the use of such apulsed laser beam can provide both ablation and coagulation. Moreparticularly, in some embodiments, time-modulated pulses of an ablativelaser beam produce tissue ablation in an ablation area, followed bytissue coagulation around the ablation area.

A laser or laser beam of a device described herein can have any powerand any peak or average emission wavelength not inconsistent with theobjectives of the present disclosure. For example, in some embodiments,a laser or laser beam of a device described herein has a peak or averageemission wavelength in the infrared (IR) region of the electromagneticspectrum. In some such cases, the laser or laser beam has a peak oraverage emission wavelength in the range of 1-4 μm, 1-3 μm, 2-4 μm, 2-3μm, 8-12 μm, or 9-11 μm. For example, in some embodiments, the laser orlaser beam comprises an erbium-doped yttrium aluminum garnet (Er:YAG)laser or laser beam or a neodymium-doped YAG (Nd:YAG) laser or laserbeam having a peak or average emission wavelength of 2940 nm or 1064 nm.In other cases, the laser or laser beam comprises a carbon dioxide laseror laser beam. A laser beam described herein can also have a peak oraverage emission wavelength in the visible region of the electromagneticspectrum. Non-limiting examples of peak or average emission wavelengthssuitable for use in some embodiments described herein include 532 nm,695 nm, 755 nm, 1064 nm, and 1470 nm (e.g., for non-ablativeapplication), or 2940 nm (e.g., for ablative application). Further, insome instances, a laser or laser beam of a device described herein hasan average power of 1 to 100 W (e.g., when used for coagulation) or 5 to200 W (e.g., when used for ablation).

Moreover, the spot size of a laser beam produced by a laser describedherein may also vary. Any spot size not inconsistent with the objectivesof the present disclosure may be used. In some cases, for instance, thespot size is 0.1-10 mm, 0.1-1 mm, 0.1-0.5 mm, 0.5-5 mm, 1-10 mm, or 1-5mm. Other spot sizes may also be used.

A BBL source of a device described herein generally produces a pulsedlight output. In some cases, the BBL source comprises a xenon gas-filledchamber. In such instances, the BBL source can produce a BBL beam by theapplication of bursts or pulses of electrical current through thexenon-containing chamber.

It is further to be understood that the depth of tissue ablation,removal, or destruction performed by a laser or BBL source describedherein can vary. Any depth not inconsistent with the objectives of thepresent disclosure may be used. For example, in some embodiments, alaser or BBL ablation step removes at least 90%, at least 95%, at least98%, or at least 99% of tissue of a targeted skin component,constituent, or area to a depth of up to 1000 μm or to a depth of up to2000 μm. In some cases, an ablation step removes at least 90%, at least95%, at least 98%, or at least 99% of tissue of a targeted skincomponent, constituent, or area to a depth of 50-2000 μm, 50-1000 μm,50-500 μm, 50-300 μm, 50-200 μm, 75-500 μm, 100-2000 μm, 100-1000 μm,100-500 μm, 100-300 μm, 100-200 μm, 200-2000 μm, 200-1000 μm, 200-500μm, 400-2000 μm, 400-1000 μm, 500-2000 μm, 500-1000 μm, or 1000-2000 μm.Other depths are also possible, and the depth is not particularlylimited. Further, it is to be understood that “removing” tissue includesablating, vaporizing, destroying, and otherwise removing the tissue.

As described further herein, a laser or BBL beam produced by a laser orBBL source of a device described herein generally has an optical pathwithin the interior compartment of the device between the proximal endand the distal end of the device. Further, the optical path exits theinterior compartment through the optical aperture. The optical path canhave any length and/or shape not inconsistent with the objectives of thepresent disclosure, and the precise length and/or shape of the opticalpath is not particularly limited.

In some embodiments, a device described herein also comprises a lightsource other than the laser or BBL source described above. Inparticular, a device described herein can comprise a light source forilluminating an area or surface that is to be imaged and/or treated bythe device. Any light source not inconsistent with the objectives of thepresent disclosure may be used. For instance, in some cases, the lightsource comprises or is a non-laser light emitting diode or device (LED).The light source may also be an incandescent or fluorescent light bulb.Other light sources may also be used. Additionally, the light source ofa device described herein can be positioned or located on any portion ofthe device not inconsistent with the objectives of the presentdisclosure, provided that the light source is capable of illuminatingthe target area of the device. For example, in some embodiments, thelight source is positioned or located adjacent to the optical apertureof the device. Other locations of the light source are also possible.

Devices described herein further comprise a camera. In some cases, thecamera is positioned or configured to receive light from the opticalaperture of the device. The light can have a second average wavelength.Additionally, in some embodiments, the light can have a second opticalpath within the interior compartment. It is also possible, in somecases, for the camera to be positioned or configured to receive lightfrom a target area without receiving light through the optical aperture.For instance, in some cases, a camera of a device described hereinproduces or records an image of a target area using an optical path thatis outside of the interior compartment of the device in which the firstoptical path of the laser or BBL beam is located. In some instances,such a camera is placed or positioned outside of the interiorcompartment of the device. For example, the camera can be attached to anexterior portion of a handpiece or other portion of a device describedherein. In some such cases, the camera is directed to receive light fromand/or image a target area of a surface of skin (or other surface) thatcan be treated with a laser or BBL beam of the device in a mannerdescribed herein.

Any camera not inconsistent with the objectives of the presentdisclosure may be used, regardless of whether the camera is positionedto receive light and/or image a target area along an optical path withinan interior compartment of a device described herein, or outside of theinterior compartment. For example, in some cases, the camera comprises adigital camera capable of capturing, recording, and/or processingtwo-dimensional or three-dimensional images of a target area. Further, acamera described herein can be a visible light camera or an infraredcamera. Other cameras may also be used.

Devices described herein, in some cases, also comprise a selectivelyreflective optical element disposed in the first optical path and in thesecond optical path, wherein the selectively reflective optical elementgenerally transmits the laser or BBL beam incident on the opticalelement. For example, in some cases, the selectively reflective opticalelement transmits at least 70% of the laser or BBL beam incident on theselectively reflective optical element, or is at least 70% transparentto the first average wavelength of the laser or BBL beam. Moreover, theselectively reflective optical element generally reflects light to thecamera from an imaged target area and/or from an optical aperture of thedevice. For instance, in some embodiments, the selectively reflectiveoptical element reflects to the camera at least 1% of the totalintensity of incident light received from an imaged area and/or opticalaperture, or is at least 1% reflective to the second average wavelengthof the light received through the optical aperture or otherwise receivedfrom the imaged area, which may be the targeted area. In some cases, theselectively reflective optical element has optical properties inaccordance with Tables I and II below.

TABLE I Percentage of Laser or BBL Beam Transmitted by SelectivelyReflective Optical Element or Percent Transparency of the SelectivelyReflective Optical Element to the Average or Peak Wavelength of theLaser or BBL Beam. Percent Transparency Percentage of Laser or BBL Beamof Optical Element Transmitted (based on total incident to Laser or BBLBeam (based intensity) on total incident intensity) ≥30% ≥30% ≥50% ≥50%≥60% ≥60% ≥70% ≥70% ≥75% ≥75% ≥80% ≥80% ≥85% ≥85% ≥90% ≥90% ≥95% ≥95%≥99% ≥99%

TABLE II Percentage of Light from the Aperture or Imaged Area Reflectedby Selectively Reflective Optical Element or Percent Reflectance of theSelectively Reflective Optical Element to the Average or Peak Wavelengthof the Light Received from the Aperture or Imaged Area. Percentage ofLight Percent Reflectance of Reflected to Camera Optical Element toLight (based on total incident intensity) (based on total incidentintensity)  ≥1%  ≥1%  ≥5%  ≥5% ≥10% ≥10% ≥20% ≥20% ≥30% ≥30% ≥40% ≥40%≥50% ≥50% ≥60% ≥60% ≥70% ≥70% ≥80% ≥80% ≥90% ≥90% ≥95% ≥95% 10-90%10-90% 10-80% 10-80% 20-90% 20-90% 30-90% 30-90% 60-90% 60-90%

Moreover, any selectively reflective optical element not inconsistentwith the objectives of the present disclosure may be used. Further, theoptical element can have any size, shape, and/or structure notinconsistent with the objectives of the present disclosure. In someembodiments, for instance, the selectively reflective optical elementcomprises or is a selectively reflective plate. In some embodiments, theselectively reflective optical element comprises a dichroic opticalelement or plate.

In addition, in some cases, a device described herein further comprisesan applicator. As described further herein, the applicator can be usedto connect or help position one or more components of a device describedherein relative to a surface that is targeted and/or treated by thedevice. For instance, in some cases, the applicator of a device helpsalign an optical aperture of the device with a target area of skin,including in a manner that permits precise imaging and/or laser or BBLtreatment of the target area or constituents or substructures present inthe target area. In some embodiments, a device described hereincomprises an applicator attached to the distal end of the interiorchamber, wherein the applicator is configured to couple, connect, orattach device to a surface of skin of a patient. Such an applicator canhave any structure or configuration not inconsistent with the objectivesof the present disclosure. For instance, in some cases, the applicatorcomprises a bottom surface adjacent to the surface of skin. The bottomsurface can be substantially flat or planar, such as may be the casewhen the bottom surface is formed from a rigid material such as a rigidplastic or metal material. The bottom surface may also be conformal tothe surface of skin, such as may be the case when the bottom surface isformed from a flexible or drapable material. Moreover, in someembodiments, the bottom surface comprises a window that is substantiallytransparent to the laser or BBL beam and/or to the light received by thecamera. A window that is “substantially” transparent to the laser or BBLbeam and/or to the light received by the camera can transmit at least40%, at least 50%, at least 60%, at least 70%, at least 80%, at least90%, or at least 95% of the laser or BBL beam and/or the light receivedby the camera, where the percent transmission can be based on totalintensity of the laser or BBL beam and/or light received by the camerathat is incident on the window. Additionally, in some embodiments, thebottom surface of an applicator described herein can have a cutout orgap that allows passage of a laser or BBL beam, illumination light,and/or camera light described herein.

Further, an applicator described herein can be reversibly attached to asurface of skin of a patient (or to another surface). For instance, insome cases, the bottom surface of the applicator comprises or is coatedwith an adhesive for reversibly adhering the bottom surface of theapplicator to the surface of skin. Any adhesive not inconsistent withthe objectives of the present disclosure may be used. Non-limitingexamples of adhesives suitable for use in some embodiments describedherein include surgical adhesives such as those described in Duarte etal., “Surgical adhesives: Systematic review of the main types anddevelopment forecast,” Progress in Polymer Science, vol. 37, no. 8(2012), pages 1031-1050. Such adhesives may include natural orbiological adhesives, synthetic or semi-synthetic adhesives, andbiomimetic adhesives. In some embodiments, an adhesive described hereincomprises a cyanoacrylate adhesive such as a DERMABOND adhesive(available from Ethicon). In other instances, an applicator describedherein is reversibly attached to a surface of skin of a patient (or toanother surface) by a pressure differential or vacuum. For example, insome such cases, the applicator of a device described herein comprises anon-permeable chamber, and the bottom surface of the applicator formsone or more hermetic seals with the surface of skin. Additionally, thenon-permeable chamber of the applicator can be in fluid communicationwith a vacuum pump for supplying a vacuum to an interior of thenon-permeable chamber. In some such instances, the vacuum supplied tothe interior of the non-permeable chamber is strong enough to hold theapplicator in place, but not strong enough to readily cause bruising ofthe skin during a clinically relevant period of time. For example, insome embodiments, the vacuum supplied to the interior of thenon-permeable chamber is 0.10-0.40 atmospheres (atm) or 0.10-0.20 atm.

An applicator of a device described herein, in some cases, preventsrelative movement, or tracks relative movement, of the surface of skinof the patient in one or more lateral directions relative to the opticalaperture of the device. In this manner, an applicator described hereincan help ensure that a laser or BBL beam directed toward a target areaon the surface of skin is delivered precisely and accurately, includingunder clinical conditions in which a patient may be moving.

Devices described herein, in some embodiments, also comprise computerhardware and/or software for carrying out one or more diagnostic,imaging, and/or treatment steps described herein. Thus, in some cases, adevice described herein can be at least partially automated. Forexample, in some cases, a device is configured to carry out an imagingand/or treatment process according to instructions provided by acomputer as a function of space and/or time. The computer can include aprocessor and a memory storing computer-readable program code portionsthat, in response to execution by the processor, cause instructions tobe provided to one or more components of a device in a desired sequence.Any hardware and/or software not inconsistent with the objectives of thepresent disclosure may be incorporated into or used with a devicedescribed herein. Moreover, various suitable hardware and softwarecomponents will be readily apparent to those of ordinary skill in theart. Such hardware and/or software can also be used to carry out anystep or computational task not inconsistent with the objectives of thepresent disclosure. For instance, in some cases, a device comprisescomputer hardware and/or software for identifying a spatial location ofone or more constituents of skin proximate the distal end of the device,and/or treating the one or more constituents of skin followingidentification. The device may also comprise computer hardware and/orsoftware for identifying or determining a class or type, size, shape,color, estimated depth, and/or shaft angle of one or more skinconstituents. Further, the hardware and/or software can comprisesoftware for correcting and/or calibrating image non-linearities ordistortions from the second optical path or discrepancies in amechanical model used during image processing. Additionally, thecomputer hardware and/or software can be mechanically and electricallycoupled to the camera of the device, including for processing image dataand/or transmitting the image data for further processing, presentation,or display. In some embodiments, computer hardware and/or softwareincludes a controller coupled to one or more components of the device,such as to the camera of the device. As described above, the camera caninclude an image recognition device or module that detects a componentof skin (or a contrast agent associated with the skin component, asdescribed further herein) and forms an image of the labeled or unlabeledcomponent of the skin. Computer hardware and/or software of a devicedescribed herein can also include a processor configured to carry outone or more of the processes described above.

Moreover, computer hardware and/or software of a device described hereincan be used to direct the device to begin laser or BBL treatment (e.g.,ablation) at essentially “the same time” as theidentification/localization of target constituents or components isended. In other words, in some cases, imaging and treatment can occursequentially, from a clinical perspective. For instance, in some cases,the laser or BBL treatment is begun 1 minute or less, 30 seconds orless, 20 seconds or less, 10 seconds or less, 5 seconds or less, 1second or less, 0.5 seconds or less, or 0.1 seconds or less after theidentification/imaging is ended. It is also possible, in some cases, forthe laser or BBL treatment (e.g., laser ablation) to be carried outsimultaneously or nearly simultaneously with the imaging/identificationof target constituents, or partially temporally overlapping theimaging/identification. Thus, in some embodiments, a device describedherein enables rapid diagnosis (or imaging) and treatment of acondition, such as a skin condition, in a sequential or non-sequentialmanner.

Devices described herein can also comprise one or more additionalcomponents other than those described above. For instance, in somecases, a device described herein further comprises one or more lenses,mirrors, and/or actuators. Any such lenses, mirrors, and/or actuatorsnot inconsistent with the objectives of the present disclosure may beused. For example, in some embodiments, a device comprises one or morelenses, mirrors, and/or actuators for directing the light received fromthe optical aperture to the camera and/or for directing the laser or BBLbeam to one or more desired locations on a surface of skin of a patient.Many suitable lenses, mirrors, actuators, or other hardware or softwarewill be readily apparent to those of ordinary skill in the art.

It is further to be understood that a device described herein can haveany combination of properties or features described hereinabove notinconsistent with the objectives of the present disclosure.Additionally, as stated above, it should be further noted that devicesdescribed herein can also be used to provide laser or BBL source lightto surfaces or constituents or components of surfaces, or regions belowsurfaces, that may not be surfaces of skin of a human patient. Forexample, in some cases, a surface may be a surface of a non-biologicalmaterial, such as a metal surface or a polymeric surface.

Moreover, it is to be understood that systems comprising the foregoingdevices are contemplated herein. Such systems can further comprise oneor more components in addition to a device described herein. Forinstance, a system can also include a power source, an image displaydevice such as a screen or monitor, electrical cables and/or connectors,and/or one or more ergonomic structures for facilitating use of thedevice by a treatment provider such as a physician.

II. Methods of Treating Skin or a Component of Skin

In another aspect, methods of treating skin or a component, constituent,or structure of skin are described herein. It is to be understood thatsuch methods, in some cases, can be carried out using devices describedhereinabove in Section I. In some embodiments, for example, a method oftreating skin or a component of skin comprises removing, ablating,vaporizing, destroying, or otherwise treating the skin or component ofskin within a target area of a device described hereinabove in SectionI, including by directing a laser or BBL beam onto the skin or componentof skin from the device. Moreover, as described further herein, a methoddescribed herein can comprise labeling, imaging, detecting, and/ormapping the skin or component of skin prior to (or substantiallysimultaneously with) directing a laser or BBL beam onto the skin orcomponent of skin for treatment purposes. Alternatively, in otherinstances, the structure of skin is not labeled but is instead imaged ordetected in its “native” or natural state, without first labeling thestructure. It may be especially desirable to omit a labeling step whenthe relevant structure of skin is visually discernible, including in afacile manner, without the use of a labeling agent. Additionally, asdescribed further hereinbelow, a method described herein can bepartially or fully automated if desired, including for implementation bya computer.

Turning now more particularly to specific steps of methods describedherein, methods described herein comprise removing, ablating,vaporizing, destroying, or otherwise treating skin or a component,constituent, or structure of skin. Any component, constituent, orstructure of skin not inconsistent with the objectives of the presentdisclosure may be treated by a method described herein. For example, insome cases, the structure of skin is a pore, gland, hair follicle, acne,skin lesion (which may be benign, pre-malignant, or malignant), bloodvessel, or vascular lesion. Further, in some instances, the gland is aneccrine sweat gland, apocrine gland, or sebaceous gland. Other glandsmay also be targeted.

Methods described herein, in some embodiments, also comprise labeling acomponent, constituent, or structure of skin. Such labeling can becarried out in any manner not inconsistent with the objectives of thepresent disclosure. For example, in some cases, labeling comprisesapplying a contrast agent or dye to the structure of skin, which may bea pore or skin lesion. Labeling may also be carried out by marking witha pen or marker. Any contrast agent, dye, marker, or pen notinconsistent with the objectives of the present disclosure may be used.For instance, in some embodiments, the contrast agent is charged orionic. A contrast agent can also be an organic contrast agent or dye.One non-limiting example of a contrast agent that can be used in amethod described herein includes methylene blue. Other contrast agentsmay also be used. In addition, in some cases, applying a contrast agentto the structure of skin comprises applying a composition (such as asolution, cream, or paste) containing the contrast agent to the surfaceof the skin. Moreover, in some embodiments, a contrast agent is appliedto the structure of the skin electrophoretically or using iontophoresis.For instance, in some cases, the contrast agent is delivered through thelocal application of an electrical current to the skin. The use of anelectrical current or voltage may be especially preferred for labelingpores with a contrast agent such as methylene blue. Specific components,constituents, or structures of skin may be labeled in other manners aswell, as understood by one of ordinary skill in the art.

Methods described herein also comprise directing or applyingelectromagnetic radiation to skin or a specific component, constituent,or structure of skin. Electromagnetic radiation can be applied to skinor a component, constituent, or structure of skin in any manner notinconsistent with the objectives of the present disclosure. For example,in some cases, the electromagnetic radiation is a laser or BBL beamproduced by a device described in Section I hereinabove. Any such laseror BBL beam not inconsistent with the objectives of the presentdisclosure may be used. For example, in some cases, the electromagneticradiation is applied by a laser or BBL source coupled to a camera and acontroller.

More generally, various steps of a method described herein, in additionto the step of applying a laser or BBL beam to skin, or to a componentor constituent of skin, can be carried out using a computer. Thus, insome embodiments, computer-implemented methods are described herein. Insome cases, such a method is for identifying and determiningcharacteristics of skin constituents so as to guide the appropriatedelivery of therapeutic laser or BBL energy. In some instances, such amethod comprises capturing one or more images with at least one camera(such as a digital camera described hereinabove). The camera can have afixed or unvarying focal length. Additionally, if a plurality of camerasis used, each camera can have a fixed focal length, though the fixedfocal lengths of the plurality of cameras can vary from one another. Amethod described herein can further comprise compensating for one ormore optical distortions of the optical path of the camera that may bepresent. In some cases, the method also comprises cropping one or moreof the one or more images, as needed or desired, and retaining only theportion of any cropped images that is relevant to therapy performed bythe method. In some embodiments, the method further comprisesidentifying therapeutically pertinent skin constituents. Suchconstituents, in some instances, are identified by their spatiallocation, size, color, estimated depth beneath the surface of the skin,and/or estimated angle of shaft, in the event there is a shaft. A methoddescribed herein can further comprise mapping skin constituents and/orskin constituent characteristics (e.g., location) to a mechanical modelof a positioning system of the laser or BBL source, such that theposition of the laser or BBL source (and/or a laser or BBL beam providedby the laser or BBL source) is known relative to the position of therelevant skin constituents. Such a method can further comprisetransmitting the skin constituent characteristics (e.g., location) to acontroller of the laser or BBL source so that a laser or BBL beam can bedirected to one or more skin constituents as desired by a user. It is tobe understood that one or more of the foregoing steps of acomputer-implemented method can be carried out using hardwareand/software described herein.

In addition, a method described herein can include placing one or moreportions of a device described herein in direct contact with skin or asurface of skin to be imaged and/or treated. For example, in someinstances, the bottom surface of an applicator described herein isplaced in direct contact with the skin or surface of skin. In othercases, the aperture of the device is placed in directed contact with theskin or surface of skin.

As described above, methods described herein can be used to treat avariety of skin components, constituents, or structures, including toameliorate a variety of skin conditions or other conditions in a humanpatient in need thereof. It is to be understood that the skin treated bya method described herein can be located on any region of the body ofthe patient not inconsistent with the objectives of the presentdisclosure. For example, in some cases, the treatment area of the skinis within the axillae, sole or palm. The foregoing regions of the bodymay be particularly suitable for the treatment of hyperhidrosis. Thus,in some embodiments, a method of treating hyperhidrosis is describedherein.

Some embodiments described herein are further illustrated in thefollowing non-limiting examples.

Example 1 Devices for Laser Treatment of Skin

Exemplary devices for laser treatment of skin according to someembodiments described herein are further described with reference to thedrawings.

FIGS. 1, 2A, and 2B illustrate various aspects of a device for the lasertreatment of skin. Referring to FIG. 1, a device, generally designated100, for the image-guided laser treatment of different skin conditionsis shown. Treatment of skin conditions can include, but is not limitedto, sweat gland treatment and/or removal, hair treatment and/or removal,acne treatment and/or ablation, pigmented lesion treatment, vascularlesion treatment, skin cancer treatment and/or ablation, blood vesseltreatment and/or removal, capillary treatment and/or removal, etc.Notably, device 100 is configured to laser treat precisely targetedareas of a patient's skin, where the precisely targeted areas aredetermined and/or identified via an image analysis system including acamera operating in the visible or infrared portions of theelectromagnetic spectrum.

As FIG. 1 illustrates, device 100 includes an interior compartment 102having a proximal end 102A (e.g., proximal to a user), a distal end102B, and an optical aperture 104 disposed at and/or proximate to thedistal end 102B. Device 100 is a handheld device configured to begrasped by a user (e.g., doctor, nurse, surgeon, medical practitioner,medical professional, etc.) during a laser therapy procedure to treatone or more lesions and/or constituents disposed on a patient's skin S.For example and during use, optical aperture 104 can be aimed by theuser and face a surface of the patient's skin S to be treated.

A laser 106 can also be provided, disposed, and/or otherwise housedwithin a portion of interior compartment 102, for example, between thedistal and proximal ends 102A, 102B. However, it is to be understoodthat laser 106 can be located inside or outside the interior compartment102, or can be part of a system comprising the device 100, rather thanbeing located within device 100 itself. In the event the laser 106 islocated outside of the interior compartment 102 or the device 100, laser106 is optically coupled to the device 100 and/or interior compartment102. The skin S facing device 100 may include, without limitation, skinof the axillae, sole or palm. Such skin S may include one or moreconstituents (e.g., a hair, a pore, sweat gland, pigmented skin cell,blood vessel, vascular lesion, skin cancer, etc.) to be treated,removed, and/or ablated.

Laser 106 produces, or is positioned and/or configured to produce, alaser beam 106A of a first average wavelength. The first averagewavelength is from about 100-12,000 nm or 600-12,000 nm, or any subrangetherebetween (e.g., 600-800 nm, 1100-1400 nm, 1300-1500 nm, 1400-1600nm, 2000-3000 nm, 2750-2950 nm, 9,000-11,000 nm, etc.), for example,depending upon whether the laser beam is ablative or non-ablative.

In certain embodiments, laser 106 produces a laser beam having a firstaverage wavelength about 532 nm, about 694 nm, about 755 nm, about 1064nm, about 1470 nm, about 1320 nm, about 1440 nm, about 1450 nm, about1550 nm, about 2790 nm, about 2940 nm, or about 10,600 nm. Laser 106 cancomprise an Erbium-based laser (e.g., an Er:YAG laser), a carbon dioxide(CO₂) laser, a Thulium (Tm) laser, a Neodymium-based laser (e.g., aNd:YAG laser), or a combination thereof. As persons having skill in theart will appreciate, laser 106 can comprise any type of laser that issuitable for the non-invasive, ablative or non-ablative therapeutictreatment skin S consistent with the objectives of the instantdisclosure, including but not limited to selective photothermolysisprocedures.

As FIG. 1 further illustrates, laser beam 106A has a first optical path(i.e., shown in the uniform dashed line), which extends through and/oralong a length of interior compartment 102. The first optical pathextends between the respective proximal and distal ends 102A, 102B, andexits interior compartment 102 through optical aperture 104 towards skinS. Laser beam 106A can treat the patient's skin S via contacting and/orpenetrating one or more layers thereof.

Device 100 can further comprise a camera 108. Camera 108 can bepositioned or configured to receive light 108A of a second averagewavelength from the optical aperture 104. In some embodiments, a lightsource LS can emit light towards the surface of the subject's skin S,and the light can be reflected off the skin back up through aperture 104and received at camera 108. For example and in some embodiments, light108A from the skin S is reflected through the aperture 104 and routed tothe camera 108 via one or more optical elements (e.g., mirrors, lenses,dichroic filters, plates, etc.). The light 108A traverses a secondoptical path (i.e., shown in the dashed line consisting of short dashes)within interior compartment 102 between skin S and camera 108. Light108A can have a second average wavelength of light that is, for exampleand without limitation, in the visible or infrared portions of theelectromagnetic spectrum. For example, the second average wavelength oflight can be from about 390 nm to 700 nm, or a subrange thereof (e.g.,450-520 nm, 520-620 nm, 600-700 nm, etc.) or from about 700 nm to 1 mm,or a subrange thereof (e.g., 700 nm-1050 nm, 1000 nm-2000 nm,10000-50000 nm, etc.).

One or more optical elements are disposed and/or housed within interiorcompartment 102. For example, at least a first optical element 110 isdisposed in interior compartment 102 between respective distal andproximal ends 102A, 102B. In certain embodiments, first optical element110 comprises a selectively reflective plate that is placed, positioned,or disposed in the first and second optical paths. First optical element110 is selectively reflective, meaning it can reflect some light (i.e.,some wavelengths in the electromagnetic spectrum) and transmit otherlight (i.e., some other wavelengths in the electromagnetic spectrum).

For example and in some embodiments, at least about 70% of the totalintensity of the laser beam 106A incident on the selectively reflectiveoptical element 110 is transmitted. That is, first optical element 110is at least 70% transparent to the first average wavelength of lightassociated with the laser beam 106A. Further, the selectively reflectiveoptical element 110 reflects light 108A to the camera 108, and at least1% of the total intensity of incident light 108A received from theoptical aperture 104 is reflected and aimed towards camera 108. That is,first optical element 110 is at least 1% reflective of the secondaverage wavelength of light 108A. Thus, first optical element 110 isselectively reflective, meaning it is reflective of the second averagewavelength of light 108A, while simultaneously transmissive to the firstaverage wavelength of light emitted associated with laser beam 106A.

In certain embodiments, first optical element 110 comprises asemi-reflective or dichroic plate disposed in the device 100 thatadvantageously combines laser delivery with imaging, as the plate ispartially or fully transparent to the laser light (i.e., 106A) andpartially or fully reflective of the imaging wavelength (i.e., light108A). Laser beam 106A can pass through first optical element 110 and bedelivered to a target area on the skin S, while the image reflected fromthe skin S as it passes through aperture 104 is reflected from firstoptical element 110 towards and/or to camera 108.

Device 100 can further comprise one or more additional optical elementsdisposed in interior compartment 102, including but not limited to oneor more lenses, mirrors, and/or actuators for directing the lightreceived from optical aperture 104 to camera 108 and/or for directinglaser beam 106A to one or more desired locations on a patient's skin S.For example, at least a second optical element 112 can be disposedproximate distal end 102B of device 100 and opposite from the firstoptical element 110. Second optical element 112 can comprise areflective plate or mirror that is fully or substantially fullyreflective of light 108A and laser beam 106A. For example, secondoptical element 112 can reflect laser beam 106A towards skin S andreflect light 108A towards camera 108.

Still referring to FIG. 1 and in some embodiments, device 100 furthercomprises an applicator 114 attached to the distal end 102A of interiorcompartment 102. Applicator 114 may attach to and/or extend from aportion of aperture 104 and/or optionally be at least partially receivedtherein. Applicator 114 is configured to couple, connect, or attachdevice 100 to a surface of the patient's skin S to facilitate treatmentof a certain area of the patient's skin. Applicator 114 can connect todevice 100 via a connecting portion or member 115. Connecting member 115can comprise a leg disposed on one side of applicator 114, or acircular, cylindrical, and/or conical member that surrounds portions ofthe optical actuator 104 to aim and/or contain laser beam 106A.

In some embodiments, applicator 114 can comprise or be formed of metal,plastic, or combinations thereof and conform to portions of thepatient's skin S during use. For example, applicator 114 can define animaging area A on the skin S as a bottom surface 116 of applicatorcontacts the skin S. The bottom surface 116 of applicator 114 cancomprise a window (FIGS. 2A, 2B) by which an affected portion P of skinis viewed and/or imaged. An image I of the affected portion P of thepatient's skin is transmitted to camera 108 and displayed on a display118. Notably, device 100 combines imaging and laser techniques fortherapeutically treating specific constituents on a patient's skin viaan easily manipulated hand held device. Device 100 includes and/or isconnected to a computing platform CP comprising computer hardware and/orexecuting computing software for identifying a spatial location of oneor more constituents in affected portion P of skin S proximate thedistal end of the device.

FIGS. 2A and 2B are respective plan and sectional views of deviceapplicator 114. FIG. 2A is a plan view of bottom surface 116 ofapplicator 114. Bottom surface 116 is configured to be positionedadjacent and/or in contact with a patient's skin (i.e., S, FIG. 1), andover, on, and/or around an affected area or portion (i.e., P, FIG. 1)thereof, which contains one or more constituents to be imaged andtargeted for laser application. Applicator 114 connects to device 100via connecting member 115.

Referring collectively FIGS. 2A and 2B, bottom surface 116 comprises awindow 120 that is substantially transparent to both the laser beam(i.e., 106A, FIG. 1) and light (i.e., 108A, FIG. 1) received by thecamera. An affected area or portion (e.g., P, FIG. 1) of the patient'sskin can be aligned and disposed in window 120 during treatment, so thatthe affected area can be imaged and displayed on a screen forfacilitating precisely targeted laser therapy applied to specificconstituents (e.g., hair follicles, pores, pigmented skin cells,abnormal skin cells, sweat glands, etc.) of the affected area. Bottomsurface 116 can be substantially flat and/or planar, but also configuredto conform to a surface of the patient's skin during use.

In some embodiments, an adhesive is applied to bottom surface 116 ofdevice 100 for temporarily and/or reversibly adhering the bottom surface116 of applicator 114 to the patient's skin during treatment. This canminimize movement of the device, skin, and/or otherwise stabilizeapplicator 114 during treatment. An exemplary adhesive comprisescyanoacrylate.

In further embodiments, applicator 114 comprises a non-permeable chamber122 that, upon application of a vacuum, causes portions 124 of bottomsurface 116 to form one or more hermetic seals with the surface of theskin. That is, when a vacuum is applied, portions 124 of bottom surface116 can hermetically seal to or against the skin's surface for improvedtargeting and stabilization during a laser therapy procedure. Chamber122 can be in fluid communication with a vacuum pump (not shown) via afitting 126 for establishing a vacuum within the interior ofnon-permeable chamber 122.

As applicator 114 is brought into contact with the skin, the device isaligned so that target skin constituents (i.e., in portion P, FIG. 1)are visible through applicator window 120 and displayed on a screen forapplication of targeted laser therapy. Then, in certain embodiments, avacuum pump connected to chamber 122 fitting 126 is activated forsealing applicator 114 to the patient's skin. The vacuum level inchamber 122 can provide firm attachment of the applicator to the skin,and at the same time be comfortable enough for the patient. In someembodiments, a vacuum of about 10-40% or 10-20% of the atmosphericpressure is applied to chamber 120, where desired.

Example 2 Systems for Laser or BBL Treating Skin

FIG. 3 is a block diagram of an exemplary system, generally designated300, for laser or BBL treating skin. System 300 can comprise animage-guided laser or BBL treatment device 302 and a controller 304. Itis understood that controller 304 is a special purpose computerconfigured to improve the technological field of imaging and lighttherapy treatments. Such improvements are manifested in terms ofimproved targeting and light treatment of individual skin constituents(e.g., individual skin cells, cancer cells, pigmented cells, individualpigmented lesions, individual pores, individual sweat glands, etc.). AsFIG. 3 illustrates, device 302 and controller 304 can be separate (e.g.,physically separate, non-integrated, discrete) entities or components.However, a system comprised of a device 302 that is integrated with acontroller 304 is also contemplated.

Device 302 can comprise an imaging system (IS) 306 and a treatmentsystem (TS) 308. Notably, IS 306 and TS 308 can collectively improve thetargeting and treatment of discrete (i.e., individualized) skinconstituents (e.g., sweat glands, pores, pigmented lesions, etc.),without having a significant effect on the skin that surrounds thediscrete skin constituents.

In some embodiments, IS 306 is a camera (e.g., a digital camera) forimaging the skin and TS 308 is a laser or BBL source (e.g., a CO₂ laser,Er:YAG laser, etc.) for treating the skin. Device 302 is moved or guidedrelative to the patient's skin according to instructions received fromcontroller 304. As device 302 moves, controller 304 instructs TS 308 togenerate a laser or BBL beam, that device 302 can direct, treat andapply to individual skin constituents (e.g., sweat glands, pores,pigmented lesions, etc.). The instructions received at device 302 fromcontroller 304 are formulated from imaging data 310 that is collectedand/or received via IS 306 and then communicated and processed atcontroller 304. IS 306 collects or captures imaging data 310 using acamera and then sends the imaging data 310 to controller 304. Device 302and controller 304 can electrically communicate using either a wired orwireless connection. Imaging data 310 can include, for example andwithout limitation, digital data that is representative of the presenceand/or spatial locations of labeled skin constituents relative to theareas or locations of non-labeled skin.

Controller 304 is configured to receive, as input, imaging data 310 andconstruct a digitized map of the labeled skin conditions. For example,controller 304 can comprise a processor 312 configured to execute afeature recognition module 316 stored in the memory 314 of controller316. Feature recognition module 316 is configured to input imaging data310 and construct a digitized map of the labeled skin constituentsrelative to the area of skin to be treated. The locations of the mappedconstituents correspond to coordinates that identify points for laser orBBL ablation and/or laser or BBL treatment allowing for improved,targeted treatment of individually mapped skin constituents.

Controller 304 can output (e.g., via a wired or wireless connection)control signals or commands instructing device 302 to move to positionsor locations relative to the patient's skin that are centered over oneof the desired coordinates corresponding to a labeled skin constituent.Once device 302 is in a desired position, controller 304 can outputcontrol signals or commands instructing TS 308 to generate a laser orBBL beam to individually treat such constituents via ablative ornon-ablative light therapy.

As FIG. 3 illustrates, the subject matter described herein can beimplemented in software in combination with hardware and/or firmware.For example, the subject matter described herein can be implemented insoftware executed by a processor. As used herein, the terms “function”and “module” refer to hardware, firmware, or software in combinationwith hardware and/or firmware for implementing features describedherein. In an exemplary implementation, the subject matter describedherein can be implemented using a non-transitory computer readablemedium having stored thereon computer executable instructions that whenexecuted by the processor of a computer control the computer to performsteps. Exemplary computer readable media suitable for implementing thesubject matter described herein include non-transitory computer-readablemedia, such as disk memory devices, chip memory devices, programmablelogic devices, and application specific integrated circuits. Inaddition, a computer readable medium that implements the subject matterdescribed herein may be located on a single device or computing platformor may be distributed across multiple devices or computing platforms.

Various embodiments of the present invention have been described infulfillment of the various objectives of the invention. It should berecognized that these embodiments are merely illustrative of theprinciples of the present invention. Numerous modifications andadaptations thereof will be readily apparent to those skilled in the artwithout departing from the spirit and scope of the invention.

The invention claimed is:
 1. A device for light treatment of skin, thedevice comprising: an interior compartment having a proximal end and adistal end; an optical aperture disposed at the distal end; a laser orBroad Band Light (BBL) source that produces a laser or BBL beam, thelaser or BBL beam having a first optical path within the interiorcompartment between the proximal end and the distal end and exiting theinterior compartment through the optical aperture; a camera thatreceives light from the optical aperture, the light having a secondoptical path within the interior compartment; a selectively reflectiveoptical element disposed in the first optical path and in the secondoptical path, and an applicator attached to the distal end of theinterior compartment, wherein the applicator couples the device to asurface of skin of a patient, wherein the selectively reflective opticalelement transmits at least 70% of the laser or BBL beam incident on theselectively reflective optical element, wherein the selectivelyreflective optical element reflects to the camera at least 1% ofincident light received from the optical aperture, and wherein theapplicator prevents relative movement of the surface of skin of thepatient in one or more lateral directions relative to the opticalaperture, and wherein the laser or BBL beam has a peak or averageemission wavelength in the visible or infrared (IR) region of theelectromagnetic spectrum, and wherein the laser or BBL beam isnon-ablative.
 2. The device of claim 1, wherein the applicator comprisesa bottom surface adapted to be placed adjacent to the surface of skin.3. The device of claim 2, wherein the bottom surface comprises a windowthat is substantially transparent to the laser or BBL beam and to thelight received by the camera.
 4. The device of claim 2, wherein thebottom surface is substantially flat or conformal to the surface ofskin.
 5. The device of claim 2, wherein the bottom surface of theapplicator comprises an adhesive for reversibly adhering the bottomsurface of the applicator to the surface of skin.
 6. The device of claim2, wherein the applicator comprises a non-permeable chamber and thebottom surface of the applicator forms one or more hermetic seals withthe surface of skin.
 7. The device of claim 6, wherein the non-permeablechamber of the applicator is in fluid communication with a vacuum pumpfor supplying a vacuum to an interior of the non-permeable chamber. 8.The device of claim 1 further comprising computer hardware and/orsoftware for identifying a spatial location of one or more constituentsof skin proximate the distal end of the device.
 9. The device of claim 1further comprising computer hardware and/or software for identifying aclass, size, shape, color, estimated depth, or shaft angle of one ormore constituents of skin proximate the distal end of the device. 10.The device of claim 1 further comprising computer hardware and/orsoftware for correcting and/or calibrating image non-linearities ordistortions from the second optical path or discrepancies in amechanical model used during image processing.
 11. The device of claim8, wherein the computer hardware and/or software is mechanically andelectrically coupled to the camera.
 12. The device of claim 1 furthercomprising one or more lenses, mirrors, and/or actuators for directingthe light received from the optical aperture to the camera and/or fordirecting the laser or BBL beam to one or more desired locations on asurface of skin of a patient.
 13. The device of claim 1, wherein thelaser or BBL beam is ablative or non-ablative.
 14. The device of claim1, wherein the laser is an Er:YAG laser.
 15. The device of claim 1,wherein the laser comprises a hybrid laser operable to produce laserbeams having a plurality of differing wavelengths.
 16. The device ofclaim 15, wherein the hybrid laser is operable to selectively produce anablative laser beam and a coagulative laser beam.
 17. The device ofclaim 1, wherein the laser beam comprises an ablative laser beam and thelaser produces time-modulated pulses of the ablative laser beam.
 18. Thedevice of claim 17, wherein the time-modulated pulses of the ablativelaser beam produce tissue ablation in an ablation area, followed bytissue coagulation around the ablation area.
 19. The device of claim 1,wherein the device further comprises a non-laser or non-BBL light sourcefor illuminating a target area of the device.
 20. The device of claim 1,wherein the laser is a pulsed laser.
 21. A device for light treatment ofskin, the device comprising: a handpiece comprising an interiorcompartment having a proximal end and a distal end; an optical aperturedisposed at the distal end; a laser or Broad Band Light (BBL) sourcethat produces a laser or BBL beam, the laser or BBL beam having a firstoptical path within the interior compartment between the proximal endand the distal end and exiting the interior compartment through theoptical aperture; an imaging system that receives a return signal fromthe optical aperture, the return signal having a second optical pathwithin the interior compartment; a selectively reflective opticalelement disposed in the first optical path and in the second opticalpath, and an applicator attached to the distal end of the interiorchamber, wherein the applicator couples the device to a surface of skinof a patient, wherein the selectively reflective optical elementtransmits at least 60% of the laser or BBL beam incident on theselectively reflective optical element, wherein the selectivelyreflective optical element reflects to the imaging system at least 1% ofincident light received from the optical aperture, and wherein theapplicator prevents relative movement of the surface of skin of thepatient in one or more lateral directions relative to the opticalaperture, and wherein the laser or BBL beam has a peak or averageemission wavelength in the visible or infrared (IR) region of theelectromagnetic spectrum, and wherein the laser or BBL beam is ablative.